Later symptoms of Lyme disease, when it isn’t treated right away, can include more rashes, arthritis, heart palpitations or an irregular heart beat, facial palsy, severe headaches and neck stiffness, nerve pain, and problems with short-term memory.

Fortunately, that there are many antibiotic regimens that can effectively treat Lyme disease, including amoxicillin, isn’t a huge secret.

So do you need to see a “Lyme literate” doctor to get diagnosed and treated if you think you have Lyme disease?

That’s actually the last thing you want to do.

The first thing you want to understand is that the term “Lyme literate” doctors is actually kind of ironic. These are not literate doctors, at least not in the sense that they are educated and practice evidence based medicine.

Quest Diagnostics says that they have detected Lyme in all 50 states, even Arizona and Colorado, even though they are among the eight states that don’t have any of the Ixodes ticks that transmit Lyme… Are those really the states “where people are being infected?”

They are often alternative medicine providers who think that you can get Lyme disease anywhere, even if you don’t live in and haven’t traveled to an area with ticks capable of transmitting Lyme disease.

Many also diagnose folks with many different kinds of non-specific symptoms as having Lyme disease, especially because they misuse tests for Lyme disease as screening tests, or simply misinterpret the results. Tests that often lead to false positive results and folks getting misdiagnosed with chronic Lyme disease.

“Once serum antibodies to B. burgdorferi do develop, both IgG and IgM may persist for many years despite adequate treatment and clinical cure of the illness”

Murray et al. on Lyme Disease

They also often think that it is likely that if you have Lyme disease, then you are also likely to have many coinfections, including Bartonella or Mycoplasma. And that the Borrelia burgdorferi bacteria can hide in our bodies, creating persistent infections, even passing through breastmilk or causing congenital Lyme disease.

“You can access a variety of online resources and directories to locate doctors who are specifically trained in identifying and treating tick-borne illnesses. This is particularly important if you suspect that you may have Lyme disease since it is the most frequently misdiagnosed of all tick-borne diseases. Finding a Lyme-literate medical doctor (LLMD)—or a physician who is familiar with the vast range of symptoms that may indicate infection at various stages of the disease, as well as potential coinfections and other complexities—can help ensure that you get the right treatment, right away.”

IGeneX Inc. on How to Find Doctors Who Can Help with Your Tick-Borne Disease

Why does IGeneX Inc. want to help you find a Lyme-literate doctor? Maybe because IGeneX Inc. sells the tests that many Lyme-literate doctors use to diagnose Lyme disease and chronic Lyme disease! Tests that most other doctors don’t recommend doing.

“The controversy is a nice model for many similar controversies: the science doesn’t support the existence of the disease, but a dedicated group of activists, including some scientists and physicians, feel their extensive experiences more than make up for lack of data. What some of us have problems with is not only the lack of data, but also the willingness of people who believe in this to go about trying to prove it in unconventional ways, for example, relying on lab tests that are not validated.”

Lyme disease—who is credible?

Still, not everyone knows about Lyme disease.

And if you don’t mention a history of a tick bite, didn’t notice a tick bite (Lyme ticks are very small), or don’t have the classic erythema migrans rash, then diagnosis might be delayed.

Tips from Lyme Disease Country

you can prevent Lyme disease by avoiding tick bites and removing ticks as quickly as possible after they bite you, which is why it is important to do use insect repellent and do regular tick checks after spending time outdoors, especially if you were in wooded, overgrown areas or places with tall grass or unmarked trails.

just because you were bitten by a blacklegged tick, it doesn’t mean that you will develop Lyme disease. In general, only 2% of tick bites result in Lyme disease.

in most cases, ticks don’t need to be tested for Lyme disease, after all, even if the tick tested positive, it doesn’t mean that it transmitted the Lyme bacteria during a bite.

Lyme disease isn’t the only tick-borne disease that we are concerned about, so do tick checks even if you aren’t in a Lyme endemic area.

according to the American Lyme Disease Foundation, eight states, including Arizona, Colorado, Idaho, Montana, Nevada, North Dakota, Utah, and Wyoming, don’t have the Ixodes ticks that transmit Lyme disease

And know that in addition to your pediatrician, a pediatric rheumatologist or pediatric infectious disease specialist can help you if you think your child has Lyme disease. Unfortunately, late symptoms of untreated Lyme disease can be serious. That makes early diagnosis and the return of a Lyme disease vaccine important.

What about Lyme-literate doctors who say that they specialize in caring for patients with Lyme disease? Understand that the term “Lyme-literate” is simply a dog whistle for alternative medicine providers and websites who are likely to offer non-evidence based care.

That’s usually what comes to mind when people find a tick on their child or if they simply think about tick-borne diseases.

It is important to know that there are many other diseases that can be caused by many different types of ticks though, from anaplasmosis to tularemia. And since these ticks and the diseases they transmit are fairly regional, it is easy to be unfamiliar with them if you don’t live in their specific habitats.

That can especially be a problem if, for example, you are from Hawaii, where tick-borne diseases aren’t a big issue, and you travel for a camping trip to Oklahoma and your child is bitten by a tick. Will you or your doctor know what to do if your child develops symptoms of Rocky Mountain spotted fever?

How To Remove a Tick

Fortunately, if you find a tick on your child, you can decrease their chance of getting sick if you remove it quickly. That makes doing daily full body tick checks important.

Use tweezers to remove a tick, grabbing it close to the skin, and pulling it upward with steady, even pressure. A special tick-removal spoon can make it even easier!

How quickly?

At least 36 hours.

“Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.”

CDC on Preventing Tick Bites

After removing the tick, wash the bite area and your hands with soap and water and observe your child over the next few weeks for symptoms of a tick-borne disease.

Symptoms of a Tick Bite

Although some of the symptoms of tick-borne diseases are specific to the tick that bit your child, some other symptoms are common to all of them, including:

fever

headache

fatigue

muscle aches and joint pains

skin rashes

chills

Like spider bites, tick bites are usually painless. That often leads to a delay in actually figuring out that a tick has bitten your child, which makes it important to do frequent tick checks if they are doing anything that could expose them to ticks.

Many people are also surprised at how many different diseases can be transmitted by ticks, including:

Anaplasmosis – transmitted by the black-legged tick (northeast and upper midwestern United States) and the western black-legged tick (Northern California). May not cause a rash.

Ehrilichiosis – transmitted by the lone star tick in southcentral and eastern US.

Lyme disease – transmitted by the blacklegged in the northeastern U.S. and upper midwestern U.S. and the western blacklegged tick along the Pacific coast. Erythema migrans rash or Bull’s eye rash.

Powassan disease – a viral infection that is transmitted by the black-legged tick (northeastern United States and the Great Lakes region). Can cause biphasic illness, with children appearing to get better and then the symptoms reappearing again.

Rocky Mountain spotted fever – transmitted by the American dog tick, Rocky Mountain wood tick, and the brown dog tick in the U.S. Causing a classic petechial rash on the wrists, forearms, and ankles, which can then spread to the trunk.

Rickettsia parkeri Rickettsiosis – transmitted by the Gulf Coast tick in the eastern and southern United States.

STARI (Southern Tick-Associated Rash Illness) – “transmitted” by the lone star tick (central Texas and Oklahoma eastward to the the whole Atlantic coast). Children have an expanding “bull’s eye” lesion at the tick bite, like Lyme disease, but the cause is unknown.

Tickborne relapsing fever (TBRF) – spread by multiple soft ticks in the western United States which live in rodent infested cabins and can cause relapsing fever – 3 day episodes of fever, in between 7 days stretches in which a child might be fever free, over 3 to 4 weeks.

Tularemia – transmitted by dog ticks, wood ticks, and lone star ticks or by handling a sick animal, including wild rabbits, muskrats, prairie dogs, and domestic cats. Can cause an ulcer at the site of infection.

And although it can be helpful to know about all of the different tick-borne diseases and their symptoms, you should basically just know to seek medical attention if your child gets sick in the few weeks following a tick bite.

What to Know About Ticks and Tick Bites

Of course, it would be even better to reduce your child’s risk of getting a tick-borne disease by avoiding ticks in first place, including limiting his exposure to grassy and wooden areas, wearing protective clothing, using insect repellent, treating your dogs for ticks, taking a shower within two hours of possibly being exposed to ticks, and doing frequent tick checks.

In addition to avoiding ticks, it is important to know that:

The Vermont Department of Health advises that the best way to prevent tickborne diseases is to prevent tick bites.

Tick activity is seasonal, with adult ticks most active in spring and fall, and the smaller nymphal ticks more active in late spring and summer.

Tick bites that lead to tick-borne diseases are often not noticed because they are usually painless and are often caused by nymphs, the immature, smaller forms of a tick. So while you might be thinking about a large, adult tick when you are asked about a recent tick bite, a nymph is tiny (about 2mm long) and might even be missed.

Testing (on your child), including antibody tests, can be done to confirm a diagnosis of most tick-borne diseases, but keep in mind that testing can be negative early on. You also shouldn’t wait for results before starting treatment in a child with a suspected tick-borne disease. Testing is usually done with either indirect immunofluorescence antibody (IFA) assay or enzyme immunoassay (EIA) tests.

It is usually not recommended that you have a tick that has bitten your child be tested for tick-borne diseases. Even if the tick was positive for something, it wouldn’t mean that it transmitted the disease to your child.

Experts don’t usually recommend that people be treated for tick-borne diseases after a tick bite unless they show symptoms. The only exception might be if the tick was on for more than 36 hours and you were in an area with a high risk for Lyme disease.

Although doxycycline, one of the antibiotics often used to treat tick-borne diseases, is often restricted to children who are at least 8 years old because of the risk of side effects, it should still be used if your younger child has Rocky Mountain spotted fever, ehrlichiosis, or anaplasmosis.

You should also know that most old wives tales about ticks and tick bites really aren’t true. You should not try to burn a tick that is biting your child with a match, paint it with nail polish, or smother it with vaseline, etc. Just remove it with tweezers and throw it away in a sealed bag or by flushing it down the toilet.

What to Do If a Tick Bites Your Child

Don’t panic if a tick bites your child. You have up to 36 hours to remove it, before it is can likely transmit any diseases to your child, like Lyme disease or Rocky mountain spotted fever.

Like this:

While other measures are important too, insect repellents are typically the best way to protect your kids from biting insects and ticks. Photo by James Gathany.

As we become more and more aware of diseases that can spread from the bites of insects and ticks, it becomes important that we learn to protect our kids. Plus, itchy bites can turn into nasty scabs that your kids pick at over and over, leaving scars that might even get infected.

What should you do?

Insect Repellents for Kids

In addition to simply trying to avoid mosquitoes and ticks, which can be difficult, especially as your kids get older and spend more time outside, you should learn to protect them with insect repellents.

Are insect repellents safe for kids?

Despite all of the warning about chemicals and toxic pesticides that you might read on the internet, the answer is of course they are. In fact, many insect repellents can even be used on infants as young as age two months. And it is certainly better than your kids getting Chikungunya, Dengue, Lyme disease, Rocky Mountain Spotted Fever, West Nile, or Zika. Or MRSA from an infected bite.

You do have to use them correctly though.

Choosing a Safe and Effective Insect Repellent

If using the new EPA label, your insect repellent will tell you how long it will protect your kids against mosquitoes and ticks.

Which insect repellent should you use?

Although traditionally insect repellents with DEET have long been “considered the best defense against biting insects,” the CDC has now said that some other DEET-free alternative insect repellents may work as well as lower dose DEET, including those with 2-undecanone, Picaridin, IR3535, oil of lemon eucalyptus, and 2% soybean oil.

Of course, that has led to a lot of new insect repellents on store shelves these days. And to a lot of confused parents trying to decide which is the best for their kids.

Don’t be one of them.

When choosing one of these insect repellents, start with the fact that none should be used on infants under two months of age and products containing oil of lemon eucalyptus should not be used on children under age three years. Otherwise, choose the product best suited to your child’s needs, especially considering that:

In addition to the active ingredient and it’s strength (how long it lasts), you can now decide if you want an insect repellent that sprays on smooth and dry and isn’t greasy, has a light, tropical scent, or is unscented. Or instead of a spray (pump or aerosol), you can even choose insect repellent wipes or a lotion.

Do keep in mind that the CDC advises that products above 30% DEET reportedly do not provide any extra protection, although it doesn’t keep stores from selling sprays with as much as 100% DEET. For other products, those with higher concentrations of DEET aren’t necessarily stronger, they simply provide longer protection.

So if you are going for a walk around the neighborhood with your preschoolers, some good choices might be:

Avon Skin-So-Soft Bug Guard Plus Towelettes (IR3535)

BioUD Spray (2-undecanone)

Buzz Away Spray (Citronella oil)

Cutter All Family Spray (7% DEET)

Cutter Lemon Eucalyptus Spray

Cutter Natural Spray

Cutter Skinsations (7% DEET)

OFF! FamilyCare II (5% Picaridin)

OFF! FamilyCare III (5% DEET)

OFF! FamilyCare IV (7% DEET)

There are many other brands too, including Sawyer, Repel, and discounted store brands from CVS, Target, and Walgreens, etc.

Using Insect Repellents on Kids

Now that you have chosen your insect repellent, be sure to use it safely.

That means reading the label and following the instructions carefully, being sure to:

only apply the proper amount of insect repellent to exposed skin or clothing

avoid spraying insect repellent inside your home or car, directly on your child’s face (apply to your own hands and then rub it on their face) and hands (they might rub their eyes or put their hands in their mouth), or allowing them to spray it on themselves

instead of insect repellent, consider using mosquito netting to cover your infant’s stroller or carrier when outside, and especially when in high risk parts of the world, using insecticide treated bed nets

It can also help to mosquito-proof your home and work to control mosquitoes and ticks where your child plays. And of course, have your child cover up and dress to avoid getting bit when possible, with long socks and clothing that covers their arms and legs.

Facts About Insect Repellents for Kids

Other things to know about insect repellents for kids include that:

Protect times can be different for protection against mosquitoes vs ticks.

IR3535, also known as Insect Repellent 3535, is a synthetic biopesticide (ethyl butylacetylaminopropionate). It was once only found in Avon Skin So Soft products, but can now be found in other brands too.

It is the chemical in oil of lemon eucalyptus, PMD or para-menthane-3,8-diol, that gives it pesticidal properties.

Avoid combination sunscreen/insect repellent products. Use separate products instead, applying the sunscreen first and reapplying the sunscreen every few hours as necessary. Since you don’t typically reapply insect repellents (unless you are going to be outside for a really long time), if your child starts to get bitten, next time, you will likely need to consider using an insect repellent with a different active ingredient or at least one with a stronger concentration that might last longer.

Although available, insect repellent lotions are often harder to find in stores.

Don’t be fooled by natural insect repellents that ‘smell amazing’ and say that they aren’t “full of chemicals.” They likely contain para-menthane-3,8-diol, ethyl butylacetylaminopropionate, or other chemicals. While they are DEET-free and some may be natural, they aren’t free of chemicals. And keep in mind that many natural insect repellents are non-EPA registered.

Call poison control (1-800-222-1222) if your child gets the insect repellent in their mouth or eyes or has a reaction.